我国医疗服务市场供给诱导需求现象的现状研究
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摘要
研究目的:通过对我国医疗资源供给量与利用量之间的关系进行相关、回归分析,判断我国不同地区供给诱导需求现象对医疗资源利用量的影响及其程度大小,为政府制定政策提供科学、合理的依据。
研究方法:本论文结合理论剖析与实证分析,对我国医疗服务市场中的供给诱导需求现象进行定性和定量研究。定量研究利用2007年《中国统计年鉴》和《中国卫生统计年鉴》中的相关数据,采用双对数线性模型对整体及按不同方式分区的各地区做回归分析,来判断供给诱导需求的程度。
研究结果:1、供给诱导需求可以为医方带来可观的利润,能对医方产生极大的激励,可以弥补供给方因竞争而导致的收入损失。在没有其它约束条件的情况下,供给方极有可能采用诱导需求行为,而且会将需求诱导至一个相当可观的程度。但同时,供给方不会将需求诱导至无限的程度,因为诱导需求也需要成本,如果不存在其他制约因素,供给方提供医疗服务的最优数量将在边际收益等于边际成本的点达到。
2、我国平均每千人口拥有卫生技术人员的数量为4.03人,且最大值和最小值之间的差距较大,每千人口卫生技术人员数的最多的省份比最少的省份多出4.0倍,反映出我国各地区医疗资源的分布极不均衡。
3、通过模型回归分析,结果发现每千人口卫生技人员数平均每增加1%,人均诊疗次数和人均医疗费用将分别增加0.971%、1.118%。按每千人口卫生技术人员数和年人均家庭收入进行分组后研究发现,在医疗资源不足的地区,人们的购买能力也比较低,供给增加的结果是人们就医可及性增加,而在医疗资源充足的地区,人们富有购买的能力,供给诱导需求的现象比较严重。
研究结论:供给诱导需求是依存于医疗服务市场的一种特殊现象,其产生的原因是多方面的,而在诸多影响医疗服务需求的因素中,以每千人口卫生技术人员数和年人均家庭收入影响最为显著,两者分别代表医疗服务的供给和人们对医疗服务的购买能力。遏制诱导需求的发生,需要政府从整体上进行控制,并对供需双方进行干预。
Objective:By use of the correlation、regression analysis between the supply and utilization of health resources in China,to estimate the influence of supplier induced demand on health resources utilization and the extent of the impact in different areas of the medical use of resources and the extent of the impact of size, to provide a scientific and rational basis for government to make policies.
Method: This paper combine theoretical analysis and empirical analysis to research the phenomenon of supplier induced demand in health service market of China. Quantitative Study use the relevant data from both "China Statistical Yearbook" and "China's Health Statistics Yearbook" in 2007,estimate the degree of supplier induced demand by dual log-linear model ,as a whole and in the district by the different ways.
Results: 1、The supplier induced demand phenomenon can generate substantial profits for the supplier side,and have a significant incentives, will be able to offset the loss of income because of competing. The supplier side very likely induced demand, in the absence of other restraining conditions, and the demand will be induced to a considerable extent. At the same time, the suppliers will not induced demand to an infinite level ,because of the cost .If there is no other constraints, the provision of the optimal health services will be the point which marginal benefit equivalent to the marginal cost.
2、The number of health professionals per 1,000 population is 4.03 in China,and have a larger gap between the minimum and the maximum ,the maximum number of health staff per 1,000 is more than at least 4.0 times in the minimum ,reflecting China's regional distribution of medical resources is uneven.
3、Through regression analysis, the results showed that health staff per 1,000 population increase average 1%, the average clinic visit and medical expenses number per capita will increase 0.971%, 1.118%. The study found that in areas with inadequate medical resources, the people's purchasing power is relatively low, the supply increase is the result of medical utilization facilely, and in health care adequate resources of the region, people's purchasing ability is higher, the phenomenon of supplier induced demand is quite serious, when grouping all province by number of health staff per 1,000、per capita household income .
Conclusion: Supplier induced demand is a special phenomenon which dependent on the health services market and its reasons are manifold. In many factors which impact on health services demand, number of health staff per 1,000 and per capita household income significant impact on demand, representing both the supply of medical services and people’s purchasing power. Curb the occurrence of induced demand, need to control the whole by government, and both supply and demand intervention.
研究方法:本论文结合理论剖析与实证分析,对我国医疗服务市场中的供给诱导需求现象进行定性和定量研究。定量研究利用2007年《中国统计年鉴》和《中国卫生统计年鉴》中的相关数据,采用双对数线性模型对整体及按不同方式分区的各地区做回归分析,来判断供给诱导需求的程度。
研究结果:1、供给诱导需求可以为医方带来可观的利润,能对医方产生极大的激励,可以弥补供给方因竞争而导致的收入损失。在没有其它约束条件的情况下,供给方极有可能采用诱导需求行为,而且会将需求诱导至一个相当可观的程度。但同时,供给方不会将需求诱导至无限的程度,因为诱导需求也需要成本,如果不存在其他制约因素,供给方提供医疗服务的最优数量将在边际收益等于边际成本的点达到。
2、我国平均每千人口拥有卫生技术人员的数量为4.03人,且最大值和最小值之间的差距较大,每千人口卫生技术人员数的最多的省份比最少的省份多出4.0倍,反映出我国各地区医疗资源的分布极不均衡。
3、通过模型回归分析,结果发现每千人口卫生技人员数平均每增加1%,人均诊疗次数和人均医疗费用将分别增加0.971%、1.118%。按每千人口卫生技术人员数和年人均家庭收入进行分组后研究发现,在医疗资源不足的地区,人们的购买能力也比较低,供给增加的结果是人们就医可及性增加,而在医疗资源充足的地区,人们富有购买的能力,供给诱导需求的现象比较严重。
研究结论:供给诱导需求是依存于医疗服务市场的一种特殊现象,其产生的原因是多方面的,而在诸多影响医疗服务需求的因素中,以每千人口卫生技术人员数和年人均家庭收入影响最为显著,两者分别代表医疗服务的供给和人们对医疗服务的购买能力。遏制诱导需求的发生,需要政府从整体上进行控制,并对供需双方进行干预。
Objective:By use of the correlation、regression analysis between the supply and utilization of health resources in China,to estimate the influence of supplier induced demand on health resources utilization and the extent of the impact in different areas of the medical use of resources and the extent of the impact of size, to provide a scientific and rational basis for government to make policies.
Method: This paper combine theoretical analysis and empirical analysis to research the phenomenon of supplier induced demand in health service market of China. Quantitative Study use the relevant data from both "China Statistical Yearbook" and "China's Health Statistics Yearbook" in 2007,estimate the degree of supplier induced demand by dual log-linear model ,as a whole and in the district by the different ways.
Results: 1、The supplier induced demand phenomenon can generate substantial profits for the supplier side,and have a significant incentives, will be able to offset the loss of income because of competing. The supplier side very likely induced demand, in the absence of other restraining conditions, and the demand will be induced to a considerable extent. At the same time, the suppliers will not induced demand to an infinite level ,because of the cost .If there is no other constraints, the provision of the optimal health services will be the point which marginal benefit equivalent to the marginal cost.
2、The number of health professionals per 1,000 population is 4.03 in China,and have a larger gap between the minimum and the maximum ,the maximum number of health staff per 1,000 is more than at least 4.0 times in the minimum ,reflecting China's regional distribution of medical resources is uneven.
3、Through regression analysis, the results showed that health staff per 1,000 population increase average 1%, the average clinic visit and medical expenses number per capita will increase 0.971%, 1.118%. The study found that in areas with inadequate medical resources, the people's purchasing power is relatively low, the supply increase is the result of medical utilization facilely, and in health care adequate resources of the region, people's purchasing ability is higher, the phenomenon of supplier induced demand is quite serious, when grouping all province by number of health staff per 1,000、per capita household income .
Conclusion: Supplier induced demand is a special phenomenon which dependent on the health services market and its reasons are manifold. In many factors which impact on health services demand, number of health staff per 1,000 and per capita household income significant impact on demand, representing both the supply of medical services and people’s purchasing power. Curb the occurrence of induced demand, need to control the whole by government, and both supply and demand intervention.
引文
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[19]苏红.过度医疗的经济学分析.卫生经济研究,2004 ,9:38-40.
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[2] G.Mc.Guire.Physician Agencyin.Handbook of Economics.Elsevier,Amsterdaln.2000,503-519.
[3] M . Gaywor . W . B . Vogt . Antitrust and Competition . Health Care Market.2000.1415-1417.
[4] Dranove.D.Demand inducement and the physician/patient relationship. Economic Inquiry ,1988 (2):281–298.
[5] V.R.Fuchs.The Health Economics.Harvard University Press.Cambridge.1986.
[6] Rice T, Labelle R.J.Do physicians induce demand for medical services? Health Political, Policy and Law.1989, 14 (3):587–600 .
[7] Donaldson C., Gerrard, K.Paying general practitioners: shedding light on the review of health services. Journal of the Royal College of General Practice.1989,39:114–117 .
[8] Richardson J. The inducement hypothesis: that doctors generate demand for their own services. Health,Economics,and Health Economics.1981:189–214.
[9] Cromwell , J , Mitchell, J.B . Physician-induced demand for surgery . Health Economics.1986,5:293–313 .
[10] Phelps, C . Induced demand—can we ever know its extent? Journal of Health Economics.1986,5:355–365.
[11]不完美信息、供给者诱导需求和医疗服务质量.财经研究.2007,33(8):97–107.
[12]朱生伟.供给诱导需求:医改中被忽视的问题[J].中南民族大学学报(人文社会科学版),2006,26(3):112-115.
[13]国家统计局.2007年中国统计年鉴.北京:中国统计出版社,2007.
[14]卫生部.2007年中国卫生统计年鉴.北京:中国协和医科大学出版社,2007.
[15]毛正中,蒋家林.我国诱导需求的数量估计.中国卫生经济.2006,25(1):65~67.
[16]王凡,温小霓.医疗供方诱导需求及其在我国的实证研究.中国卫生经济.2007,26(3):7-10.
[17]孙学英,潘海涛.中国人口因素对寿险需求影响的实证分析.统计与信息论坛.2007,22(2):69-74.
[18]吴明.卫生经济学.北京:北京医科大学出版社,2002.
[19]程晓明.卫生经济学(第2版).北京:人民卫生出版社,2007.
[20]富兰德,古德曼,斯坦诺.卫生经济学.王健,孟庆跃译.第3版.北京:中国人民大学出版社,2004.220.
[21]王凡.我国医疗供方诱导需求理论与实证研究:[硕士学位论文].陕西:西安电子科技大学.
[22]陈晓阳,杨同卫.关于过度医疗的经济学分析与伦理.医学与哲学.2003,24(9):13-14.
[23]保罗·J·费尔德斯坦.卫生保健经济学.北京:经济科学出版社,1998.132.
[24] Stuart J Peacock,Jeffrey R J Richardson.Supplier induced demand re-examining identification and isspecification in cross-sectional analysis.European Journal of Health Economics,2007,(8):267-277.
[25]陶月玉,钱介荣,庄永忠,等.信息不对称对医患关系的影响及应对策略.中国医院,2004,8(1):50-52.
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